Medicine Price. Monitor. for uganda. #12 July-September Ministry of. World Health organisation. Health Action International

Transcription

1 Medicine Price Monitor for uganda #12 July-September 2014 Ministry of Health World Health organisation HEPS Uganda HAI AFRICA Health Action International

2 MEDICINE PRICE MONITOR FOR UGANDA study team Survey manager Sebagereka Anthony Data collectors Prima Kazoora Joseph Mangusho Paul Akankwasa Francis Oboi Alice Twesigye Francis Abura Kenneth Mwehonge James Achol Erienyu Administrator Monica Opus Data entry Aliyo Bestason Julian Komuhangi B

3 No. 12: July-September 2014 TABLE OF CONTENTS ABBREVIATIONS AND ACRONYMS... II 1. BACKGROUND Introduction Objectives of the Survey Methodology Survey design Sampling Data analysis and management Limitations of the study RESULTS AND DISCUSSION Availability Overall availability of essential medicines across the three sectors A comparison of availability of anti-malarial medicines across sectors A comparison of availability of anti-diabetic medicines across sectors A comparison of availability of anti-hypertensive medicines A comparison of availability of paediatric formulations across sectors Medicine prices Affordability CONCLUSION AND RECOMMENDATIONS Conclusion Recommendations REFERENCES ANNEXES Annex 1: Overall availability of Medicines across the three sectors Annex 2: A comparison of the availability of anti-malarial medicines across sectors Annex 3: Overall availability of 40 essential medicines across sectors Annex 4: Median unit price of the 40 medicines in the private and mission facilities I

4 MEDICINE PRICE MONITOR FOR UGANDA ABBREVIATIONS AND ACRONYMS CSO DANIDA DHO DFID EMHS HAI HEPS HSSIP MeTA MMP MoH MPR NDA NGO NMS NPSSP PFP PNFP WHO UGX Civil society organisation Danish International Development Agency District Health Officer Department For International Development Essential Medicines and Health Supplies Health Action International Coalition for Health Promotion and Social Development Health Sector Strategic and Investment Plan Medicines Transparency Alliance Monitoring of Medicines Prices and Availability Ministry of Health Median price ratio National Drug Authority Non-governmental organisation National Medical Stores National Pharmaceutical Sector Strategic Plan Private for profit Private Not for Profit (Mission) World Health Organisation Uganda Shillings II

5 No. 12: July-September BACKGROUND 1.1 Introduction Medicines Transparency Alliance (MeTA) Uganda undertook a survey to estimate medicine availability and prices. The survey is part of a series that started in 2002 to inform policy interventions to address access challenges related to low availability and unaffordable prices. 1.2 Objectives of the Survey 1) To determine the availability of medicines in the public, private and mission sectors; 2) To compare the prices of medicines in private sector across the public, private and mission sectors; and 3) To assess the affordability of treating key conditions 1.3 Methodology Survey design The survey was conducted using a standardised methodology developed by World Health Organisation (WHO) and Health Action International (HAI) 1. The survey utilised mainly quantitative methods to assess availability and prices of medicines in the public, private and mission sectors. Using the WHO/ HAI methodology, the lowest-prices of medicines available in the facilities were collected and compared with international reference prices to obtain a median price ratio (MPR). Daily income of the lowest paid government employee was used to assess the affordability of the medicines Sampling The survey was conducted in all four major regions of Uganda central, eastern, western, and northern. The survey was conducted in 119 public, private and mission health facilities and medicine outlets. The selection of a basket of 40 essential medicines was based on the methodology s core and supplementary lists. The list was approved by the Pharmacy Division of Ministry of Health

6 MEDICINE PRICE MONITOR FOR UGANDA Table 1: Distribution of health facilities surveyed Public Private Mission Northern Eastern Western Central Total Rural Urban Rural Urban Rural Urban Data analysis and management For each medicine, data on the lowest priced product (brand) that was physically available on the day of the visit was collected. All the data collection forms were checked for completeness and accuracy. Data analysis was done using the customised WHO/ HAI Excel workbook. Affordability was measured using a benchmark of one day s wages of the lowest paid government worker and a given treatment regimen was considered not affordable if they were more than one days wages. The following disease conditions were used in the calculations to reflect the affordability of the respective treatments; diabetes mellitus, hypertension, anxiety, Urinary Tract Infections (UTI for adults), asthma, acute respiratory infection (children and adults), peptic ulcers, arthritis, depression and malaria Limitations of the study The study design being cross-sectional in nature yields data which may not depict consistency in the availability of the medicines in the health facilities throughout the year. 2

7 No. 12: July-September RESULTS AND DISCUSSION This section highlights the results of the study focusing on the availability and prices of the key essential medicines across all the three sectors, as well as their affordability. It also includes comparisons in availability of the medicines for this survey, with the findings previous survey (July-September 2013). 2.1 Availability Overall availability of the 40 essential medicines across the three sectors Table 2 and Figure 1 show the overall availability of medicines in the three sectors and comparisons between rural and urban facilities. Table 2: Overall availability of medicines in the surveyed facilities Sector No. of facilities Median availability Public Private Mission Overall 39 69% Urban 16 69% Rural 23 67% Overall 41 73% Urban 31 81% Rural 10 60% Overall 79% Urban 16 84% Rural 23 74% Overall, the availability of the surveyed medicines was highest in the mission sector (79%), followed by private sector (73%), and lowest in the public sector (69%). This shows a comparable trend of a steady increase in availability of the selected essential medicines, in all the sectors, when compared with the past survey in July 2013; that is, an increment by 24, 8 and 1 percentage points, respectively. Overall, urban facilities had relatively higher availability as compared to rural facilities across all the three sectors, as summarised in Figure 1. 3

8 MEDICINE PRICE MONITOR FOR UGANDA Figure 1: Availability in urban versus rural facilities, Jul-Sep 2014 With reference to Figure 1, a difference in medicines availability between urban and rural healthcare facilities of 2% was observed among the surveyed public sector facilities, a difference of 10% in the mission sector facilities and a difference of 21% in the private sector facilities. Whereas there was a marginal variation in the public sector facilities of 2%, consistent with last survey s findings Comparison of overall availability of selected anti-malarial medicines across sectors As illustrated in Figure 2, public sector health facilities had the highest availability of Artemether/ Lumefantrine (A/L) 20/120mg tablets at 95%; followed by private facilities at 93%; and mission facilities at 90%. This trend shows a marked increase in availability of A/L in both the public and private facilities by 6 and 18 percentage points, respectively. The availability of Quinine injection, on the other hand, was highest in mission facilities at 82%, followed by public facilities at 72%, and lowest in private facilities at 66%. This reflects gains of 37 and 9 percentage points in the mission and public facilities, respectively, and a reduction in availability in private facilities (8), when compared with findings from the MMP of July The availability of Sulfadoxine/ Pyrimethamine (S/P), mainly used for prophylaxis of malaria in pregnant women, was highest in the mission sector (85%), followed by the public sector (79%), and lowest in the private sector (68%). This showed an increase in availability of S/P in the mission and private sectors by 14 and 5 percentage points, respectively, when compared with the findings of the MMP July 2013 survey. There was no variation in the public sector. 4

9 No. 12: July-September 2014 Figure 2: Overall availability of selected anti-malarial medicines across the three sectors A/L was generally available in a higher proportion of rural than urban facilities. Figure 3: A comparison of availability of selected anti-malarial medicines across the three sectors incorporating urban and rural components. 5

10 MEDICINE PRICE MONITOR FOR UGANDA On the other hand, the difference in availability of S/P between rural and urban facilities was widest in the private sector (64 percentage points); and lowest in the public sector (8 percentage points). Table 3: Comparison of overall availability of Anti-Malarials in the MMP July-September 2014 versus the MMP July 2013 surveys Medicines Public Private Mission Artemether/ Lumefantrine Quinine injection Sulfadoxine/ Pyrimethamine 89% 95% 75% 93% 89% 90% 45% 72% 63% 66% 74% 82% 79% 79% 63% 68% 71% 85% As illustrated in Table 3, availability of A/L in the public sector increased marginally in However, the increase in availability of Quinine injection was bigger (27 perentage points). No variation was observed in availability of S/P in the public sector Comparison of availability of selected anti-diabetic medicines across sectors In general, availability of Glibenclamide and Metformin was comparable across the three sectors. Glibenclamide was available in 77% public facilities; 68% of private facilities; and in 69% mission sector. All three sectors experienced an increase in availability of Glibenclamide, with the increase being highest in the public sector (22 percentage points) when compared with the findings of the MMP July survey. On the other hand, Metformin was available in 72%, 78% and 64% in the public, private and mission facilities, respectively. Overall, availability of Glibenclamide and Metformin was observed to be higher in the urban than in rural facilities across all the three sectors, as demonstrated in Figure 4. 6

11 No. 12: July-September 2014 Figure 4: Comparison of availability of Glibenclamide and Metformin medicines across the sectors Comparison of availability of selected anti-hypertensive medicines across sectors The availability of Nifedipine 20mg was highest in the mission sector at 90%, followed by public sector at 74% and private sector at 71%. In addition, availability of Furosemide 40mg was comparable across the three sectors: 85%, 73% and 77% in the public, private and mission facilities, respectively. The availability of Propranolol 40mg was also comparable across the sectors: 69% for the public and mission facilities, and in 71% of private facilities. These findings generally reflect an improvement in availability of these medicines across the three sectors, as compared with the findings of the MMP July-Sept 2013 survey as shown in Table 4. Table 4: A comparison of overall availability of the selected Anti-hypertensives in the MMP July_2014 with the MMP July_2013 surveys Medicine Public Private Mission Furosemide tab 40mg 61% 85% 55% 73% 66% 77% Nifedipine retard tab 20mg 79% 74% 63% 71% 74% 90% Propranolol tab 40mg 39% 69% 65% 71% 69% 69% 7

12 MEDICINE PRICE MONITOR FOR UGANDA As shown in Figure 5, availability of all the three anti-hypertensives was higher in the urban than in the rural private sector facilities, with the difference being most pronounced in the case of Furosemide (17 percentage points). Figure 5: Comparison of availability of selected anti-hypertensive medicines across the three sector A comparison of availability of selected paediatric formulations across the three sectors By and large, the private sector exhibited the highest availability of paediatric formulations 88%, 78% and 59% for Amoxicillin suspension, Co-trimoxazole suspension and Metronidazole suspension, respectively. Availability of Amoxicillin suspension, Co-trimoxazole suspension and Metronidazole suspension was comparable in the mission and private sectors, while availability of these medicines in the public sector was low, especially for Amoxicillin suspension (18%) and Co-trimoxazole suspension (15%). The low availability of Amoxicillin suspension in the public sector facilities could be attributed to change in NMS policy from suspensions to supply of dispersible tablets for paediatric use. 8

13 No. 12: July-September 2014 Furthermore, urban facilities had higher availability of the selected paediatric formulations than the rural facilities. On the other hand, the public sector exhibited a very wide difference in availability of Metronidazole suspension between the rural (61%) and urban (19%) facilities, as illustrated in Figure 6. Figure 6: Comparison of availability of selected paediatric formulations across sectors incorporating both urban and rural sectors As demonstrated in Table 5, there was an improvement in the overall availability of paediatric formulations across all the sectors in 2014, when comapred to the findings of the previous study of July-September However, all paediatric formulations surveyed, save Amoxicillin suspension, had lower availability this survey than in the previous one (July-September 2013). 9

14 MEDICINE PRICE MONITOR FOR UGANDA Table 5: A comparison of overall availability of selected paediatric medicines, across the three sectors, with the findings of the previous survey (July-September 2013). Medicines Amoxicillin suspension 250mg/5ml Co-trimoxazole suspension 8/40 mg/ml Metronidazole suspension 200mg/5ml Public Private Mission % 18% 75% 88% 74% 82% 16% 15% 65% 78% 57% 64% 45% 44% 50% 59% 63% 64% Oral Rehydration Salt (ORS) 89% 81% 80% 83% 89% 83% 2.2 Medicine prices Table 6: Comparison of medicine median price ratios between and within private and mission sectors Private Urban/ Private Rural Mission Urban/ Mission Rural Private Urban/ Mission Urban Private Rural/ Mission Rural Number of times more expensive Number of Pairs analyzed As shown in Table 6, the prices of medicines in the private facilities were comparable across urban and rural facilities (ratio 1:1). Similarly, medicine prices in the mission sector were found to be comparable across the urban and rural facilities (ratio 1:1). However, medicines prices in the urban private facilities were found to be 23% more expensive than those in the urban mission facilities (ratio 1:23). Prices of medicines in the rural private facilities were found to be 33% higher than those in the rural mission facilities (ratio 1.33). 10

15 No. 12: July-September 2014 Figure 7: Median prices of paediatric formulations in private and mission facilities Generally, the median prices for paediatric formulations in the private facilities were slightly higher than those in the mission facilities with the highest difference being UGX 10 in the case of Metronidazole suspension. 2.3 Affordability Affordability was calculated as the number of days the lowest paid government worker would have to pay for one treatment course of an acute condition or one month s treatment of a chronic condition. Treatments less than or equal to one days wages were considered affordable. The daily wage of the lowest paid government worker is about UGX 6,255 (US$ 2.36) as per the Ministry of Public Service latest salary structure 1. Table 7 shows the number of days it would take the lowest paid Uganda government worker to pay for treatment of the most common diseases, in the private and mission sectors. 1 Ministry of Public Service New Salary Scales for Public servants for FY 2014/15 11

16 MEDICINE PRICE MONITOR FOR UGANDA Table 7: Affordability (Daily wage of lowest paid government worker is UGX 6255) Condition Adult Malaria Select Medicine Artemether/Lumefantrine tab 20/120mg Treatment duration (in days) No. of units per treatment Median Treatment Price (UGX) Days' wages Mission Private Mission Private Adult RTI Amoxicillin cap/tab 250mg Ceftriaxone 1g injection vial Adult UTI Ciprofloxacin tab 500mg tab Anxiety Diazepam tab 5mg Arthritis Diclofenac tab 50mg Asthma Salbutamol inhaler 0.1mg(100mcg)/dose When required Depression Amitriptyline tab 25mg Diabetes Glibenclamide tab 5mg Hypertension Nifedipine retard tab 20mg Paediatric RTI Co-trimoxazole suspension 8/40 mg/ml Pain Paracetamol tab 500mg Ulcer Omeprazole cap 20mg Affordability of treatments using Amitriptyline (for depression), Ceftriaxone (for bacterial infections), Salbutamol inhaler (Asthma treatment), Omeprazole (Peptic Ulcer disease treatment) poses a big challenge for Ugandans in the income bracket of the lowest-paid government worker, as these require more than one day s wage in order to meet the expenses in the private and mission facilities. In the private sector, A/L was seen to be more affordable at 0.8 as compared to the findings of the previous study (where it would take 1.2 days wages to meet the treatment costs). 12

17 No. 12: July-September 2014 Figure 8: Affordability of treatment for Malaria, Diabetes, Hypertension and paediatric acute respiratory tract infection As illustrated in Figure 8, Glibenclamide and Amoxicillin suspension were most affordable, requiring about half a day s wage, while Nifedipine 20mg was least affordable in the private sector among the medicines surveyed. 13

18 MEDICINE PRICE MONITOR FOR UGANDA 3. CONCLUSION AND RECOMMENDATIONS 3.1 Conclusion This survey found overall availability of medicines to have increased only marginally when compared to the previous survey results. Availability of medicines in the public sector stagnated (68-69%), while it still remained lower than in the private (73%) and mission (79%) sectors. Overall, medicines remain less affordable in the private sector when compared to the mission sector, and some medicines, such as Salbutamol inhaler and Omeprazole cap 20mg, used in the management of asthma and gastric ulcers respectively, are not affordable to people in the income bracket of the lowest-paid government worker. 3.2 Recommendations 1) MoH should consider revision of the essential medicines kit-based system in both content and quantity on a more routine basis, and develop/revise more robust monitoring systems for medicine utilisation at all levels of care to minimise waste and promote efficiency in the medicine management. These will eventually enhance equitable supply of, and access to, the essential medicines in the health facilities, as well as client satisfaction 3) Special emphasis needs to be put on increasing availability of paediatric formulations and medicines used for management of chronic ailments like Asthma, Hypertension and Diabetes 4) Government should come up with mechanisms to regulate retail medicine prices, particularly at the retail level, and encourage local production of cost-effective generic medicines for the local market 5) MoH and partners should increase the availability of S/P (especially in public health facilities) needs to be increased so as to increase the number of pregnant women that access S/P, from 25% 13, which will facilitate the efforts in eradicating malaria in pregnancy 6) MoH and NMS should tackle the continuing lower availability of medicines in rural facilities by strenghening the medicine logistics management. 14

19 No. 12: July-September 2014 REFERENCES Thompson, S. and E. Ogbe (2012). Helpdesk Report: Availability of Essential Medicines, 24. Health Action International. Medicine Prices, Availability, Affordability & Price Components. Madden, J.M., et al. Measuring medicine prices in Peru: validation of key aspects of WHO/HAI survey methodology. Revista Panamericana de Salud Pública, (4): p National Drug Policy and Authority Act, World Health Organisation, Maternal and Child Health: Uganda Ministry of Public Service. New Salary Scales for Public Servants Ministry of Health and USAID/SURE Program. Assessment of the Uganda Essential Medicines Kit- Based Supply System in Uganda Stopstockouts (2004). Fact sheet: Prices and availability affect access to medicines. World Health Organisation and Health Action International, Measuring medicine prices, availability, affordability and price components. 2nd ed Zaheer Ud Din Babar, et al., Evaluating Drug Prices, Availability, Affordability, and Price Components: Implications for Access to Drugs in Malaysia PLoS Medicine, MDG Wiki Handbook (2012) Proportion of population with access to affordable essential drugs on a sustainable basis. USAID, President s Malaria Initiative-Uganda: Malaria Operational Plan FY Ministry of Health, Uganda Demographic and Health Survey 2011 Ministry of Health, National Health Policy- Uganda

20 MEDICINE PRICE MONITOR FOR UGANDA ANNEXES Annex 1: Overall availability of Medicines across the three sectors Public sector (14 medicines with availability of over 75%) Amitriptyline Artemether/Lumefantrine Ciprofloxacin tab 500mg Co-trimoxazole tab mg Glibenclamide tab 5mg Metronidazole tab 200mg Omeprazole cap 20mg Oral Rehydration Salt (ORS) Private sector (19 medicines with availability of over 75%) Amitriptyline tab 25mg Amoxicillin cap/tab 250mg Amoxicillin susp 250mg/5ml Artemether/Lumefantrine tab 20/120mg Dextrose 5% inj Diclofenac tab 50mg Doxycycline cap/ tab 100mg Erythromycin tab 250mg Gentamycin inj 80mg/ml Paracetamol tab 500mg Mission sector (22 medicines with availability of over 75%) Aciclor tab 200mg Amitriptyline tab 25mg Amoxicillin cap/tab 250mg Amoxicillin suspension 250mg/5ml Metronidazole tab 200mg Nifedipine retard tab 20mg Omeprazole cap 20mg Oral Rehydration Salt (ORS) Diazepam tab 5mg Furosemide tab 40mg Gentamycin inj 80mg/ml Ceftriaxone 1g powder for injection Ciprofloxacin tab 500mg Co-trimoxazole susp 8/40 mg/ml Co-trimoxazole tab mg Prednisolone tab 500mg Ciprofloxacin tab 500mg Dextrose 5% inj Diazepam tab 5mg Diclofenac tab 50mg Artemether/Lumefantrine tab 20/120mg Paracetamol tab 500mg Doxycycline cap/tab 100mg Ceftriaxone 1g powder for Prednisolone tab 500mg injection Public sector (6 medicines that were less than 25% available) Paracetamol tab 500mg Sulfadoxine/Pyrimethamine (SP) tab 25/500mg Tetracycline eye ointment 1% Metformin tab 500mg Metronidazole tab 200mg Omeprazole cap 20mg Oral Rehydration Salt (ORS) Gentamycin inj 80mg/ ml Sulfadoxine/ Pyrimethamine (SP) tab 25/500mg Quinime inj 300mg/5ml Tetracycline eye ointment 1% Furosemide tab 40mg Amoxicillin suspension 250mg/5ml Co-trimoxazole 8/40 mg/ml Cimetidine tablets 400mg Methyergometrine inj 200ug/ml Private sector (one medicine was less had less than 25% availability) Nystatin pessaries iu Salbutamol inhaler 0.1mg(100mcg)/dose Methyergometrine inj 200ug/ml Mission sector (No medicine was found to have less than 25% overall availability) 16

21 No. 12: July-September 2014 Annex 2: A comparison of the overall availability of selected anti-malarial medicines in the three sectors Medicine PUBLIC Availability PRIVATE Availability Artemether/Lumefantrine tab 20/120mg 95% 93% 90% Quinine injection 300mg/5ml 72% 66% 82% Sulfadoxine/Pyrimethamine (SP) tab 25/500mg 79% 68% 85% MISSION Availability 17

22 MEDICINE PRICE MONITOR FOR UGANDA Annex 3: Overall availability of 40 essential medicines across the various sectors MEDICINE PUBLIC SECTOR PRIVATE SECTOR MISSION SECTOR Urban Rural Overall Urban Rural Overall Urban Rural Overall Aciclor tab 200mg 69% 70% 69% 81% 40% 71% 88% 78% 82% Albendazole tab 200mg 38% 65% 54% 55% 60% 56% 56% 35% 44% Amitriptyline tab 25mg 94% 87% 90% 87% 80% 85% 88% 74% 79% Amoxicillin cap/tab 250mg 75% 57% 64% 100% 90% 98% 94% 91% 92% Amoxicillin susp 250mg/5ml 25% 13% 18% 94% 70% 88% 94% 74% 82% Artemether/Lumefantrine tab 20/120mg 88% 100% 95% 90% 100% 93% 88% 91% 90% Bendrofluazide tab 5mg 75% 61% 67% 61% 30% 54% 75% 70% 72% Betamethasone cream/ointment 1%w/v 56% 30% 41% 74% 60% 71% 44% 43% 44% Carbamazepine tab 200mg 63% 70% 67% 77% 30% 66% 75% 61% 67% Ceftriaxone 1g pwder for injection 63% 48% 54% 84% 70% 80% 88% 87% 87% Cimetidine tab 400mg 6% 9% 8% 58% 30% 51% 38% 48% 44% Ciprofloxacin tab 500mg 94% 78% 85% 97% 70% 90% 100% 87% 92% Co-trimoxazole suspension 8/40 mg/ml 6% 22% 15% 81% 70% 78% 69% 61% 64% Co-trimoxazole tab mg 100% 96% 97% 84% 90% 85% 81% 70% 74% Dextrose 5% injection 81% 61% 69% 77% 70% 76% 81% 91% 87% Diazepam tab 5mg 81% 100% 92% 71% 60% 68% 88% 74% 79% Diclofenac tab 50mg 63% 48% 54% 94% 70% 88% 94% 87% 90% Doxycycline cap/tab 100mg 69% 74% 72% 94% 90% 93% 94% 87% 90% Erythromycin tab 250mg 63% 52% 56% 87% 60% 80% 69% 74% 72% Fluconazole tab /cap 200mg 50% 65% 59% 74% 40% 66% 56% 65% 62% Furosemide tab 40mg 100% 74% 85% 77% 60% 73% 88% 70% 77% Gentamycin inj 80mg/ml 94% 78% 85% 81% 60% 76% 75% 87% 82% Glibenclamide tab 5mg 81% 74% 77% 77% 40% 68% 88% 57% 69% Mebendazole tab 100mg 63% 61% 62% 81% 50% 73% 69% 65% 67% Metformin tab 500mg 88% 61% 72% 84% 60% 78% 81% 52% 64% Methyergometrine inj 200ug/ml 13% 26% 21% 26% 0% 20% 31% 22% 26% Metronidazole susp 200mg/5ml 19% 61% 44% 65% 40% 59% 69% 61% 64% Metronidazole tab 200mg 88% 91% 90% 94% 90% 93% 94% 100% 97% Nifedipine retard tab 20mg 69% 78% 74% 74% 60% 71% 88% 91% 90% Nystatin pessaries iu 6% 9% 8% 74% 20% 61% 69% 70% 69% Omeprazole cap 20mg 75% 78% 77% 94% 60% 85% 88% 83% 85% Oral Rehydration Salt (ORS) 88% 74% 79% 90% 60% 83% 88% 83% 85% Paracetamol tab 500mg 75% 87% 82% 100% 100% 100% 94% 96% 95% Phenytoin tab 100mg 63% 74% 69% 52% 30% 46% 38% 35% 36% Prednisolone tab 500mg 50% 61% 56% 94% 80% 90% 75% 83% 79% Sulfadoxine/Pyrimethamine (SP) tab 25/500mg 75% 83% 79% 84% 20% 68% 94% 78% 85% Propranolol tab 40mg 69% 70% 69% 74% 60% 71% 75% 65% 69% Quinine inj 300mg/5ml 81% 65% 72% 65% 70% 66% 88% 78% 82% Salbutamol inhaler 0.1mg(100mcg)/ dose 13% 13% 13% 65% 20% 54% 75% 43% 56% Tetracycline eye ointment 1% 75% 96% 87% 77% 50% 71% 94% 87% 90% 18

23 No. 12: July-September 2014 Annex 4: Median unit price of the 40 medicines in the private and mission facilities Medicine PRIVATE SECTOR MSSION SECTOR % price difference Aciclor tab 200mg Albendazole tab 200mg Amitriptyline tab 25mg Amoxicillin cap/tab 250mg Amoxicillin susp 250mg/5ml Artemether/Lumefantrine tab 20/120mg Bendrofluazide tab 5mg Betamethasone cream/ointment 1%w/v Carbamazepine tab 200mg Ceftriaxone 1g pwder for inj'n Cimetidine tab 400mg Ciprofloxacin tab 500mg Co-trimoxazole susp 8/40 mg/ml Co-trimoxazole tab mg Dextrose 5% inj Diazepam tab 5mg Diclofenac tab 50mg Doxycycline cap/tab 100mg Erythromycin tab 250mg Fluconazole tab /cap 200mg Furosemide tab 40mg Gentamycin inj 80mg/ml Glibenclamide tab 5mg Mebendazole tab 100mg Metformin tab 500mg Methyergometrine inj 200ug/ml Metronidazole susp 200mg/5ml Metronidazole tab 200mg Nifedipine retard tab 20mg Nystatin pessaries iu Omeprazole cap 20mg Oral Rehydration Salt (ORS) Paracetamol tab 500mg Phenytoin tab 100mg Prednisolone tab 500mg Sulfadoxine/Pyrimethamine (SP) tab 25/500mg Propranolol tab 40mg Quinime inj 300mg/5ml Salbutamol inhaler 0.1mg(100mcg)/dose Tetracycline eye ointment 1%

24 MEDICINE PRICE MONITOR FOR UGANDA MeTA Uganda Secretariat Plot 93, Buganda Road National Drug Authority Annex, Kampala, Uganda Tel: This work is licensed under 20